Provider Demographics
NPI:1679253819
Name:WAKAMIYA, ALYSSA YUKI (OD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:YUKI
Last Name:WAKAMIYA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 S PARKER RD STE C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4381
Mailing Address - Country:US
Mailing Address - Phone:303-474-5283
Mailing Address - Fax:
Practice Address - Street 1:2406 S PARKER RD STE C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4381
Practice Address - Country:US
Practice Address - Phone:303-474-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist